And third , we have an arrangement with a company , such as Medequip , whereby we hold some of their stock and issue it to patients , and then their local Medequip service will collect it from their homes and clean and recycle it , and they will regularly replenish our stock . The possible barriers include :
• Staff availability to clean , check and recycle equipment .
• Possible reluctance of patients to accept recycled equipment especially personal toileting / bathing items .
• Transport not taking large pieces of equipment , such as commodes and toilet frames .
• Lack of storage space and effective cleaning facilities .
• Delayed discharges if equipment packages are not in place .
• Liaison with community services if the patient lives alone and is unable to accept equipment due to being in hospital .
• Patients not returning equipment if we loan them our own stock .
We then engaged with several stakeholders , including : the sustainability lead and / or head of estates , to discuss storage space ; therapy staff involved in purchasing and issuing of the equipment ; the head of volunteer services ; the quality improvement team ; patients ; the Medequip community equipment service and the local council ; and transport services for the trust .
Each potential solution was explored . I had meetings with the head of estates and other members of the estates team regarding storage space , which initially looked promising , but no suitable space was available .
We were fortunate to get a new sustainability lead , who liaised with Medequip about us having a loan stock from them , but they were not able to provide this .
I met with the therapy technician who does most of the pre-admission calls to patients , to help them prepare for surgery . She reported that generally patients expect to be provided with equipment by the hospital .
I met with the lead occupational therapist for acute orthopaedics , who described complex ordering systems and different training for each of them . Due to chronic staff shortages and high turnover of staff , it did not seem to be time efficient for each occupational therapist who came through the team to be trained in multiple systems .
Our sustainability lead met with the transport department , who explained that they are not insured to carry equipment that cannot be secured in their vehicles .
Breaking through
In March this year , the trust held a competition , the Sustainable Systems Prize , asking for innovative ideas to help change systems and reduce our carbon footprint . Along with a colleague , I submitted this project – and won .
The chief executive and director of nursing both agreed that taking this forward was a ‘ no brainer ’ and could not believe it hadn ’ t already been done .
But it felt as if we would never achieve our goal . Every few weeks I would see new boxes of plastic equipment being delivered . The push to get patients home quickly after surgery meant that staff had to take the easiest option and provide what was there .
We have had a recent breakthrough ; along with my manager and sustainability lead , I met with the clinical lead for the London Community Equipment Consortium , who recently awarded NRS the contract for equipment provision for 20 London boroughs .
She has agreed to support us in getting many more therapy staff trained and provided with PINs so that they can order stock for patients before surgery in a more efficient way .
Our acute orthopaedic inpatient lead occupational therapist has written a new standard operating procedure ( SOP ) for staff regarding the issuing of equipment . We are seeing a shift in attitudes among both patients and staff , and part of the SOP includes providing information to patients about where they can recycle equipment .
The next step is to ensure that staff are supported to complete the training and are able to order equipment for patients from their local equipment service in a timely manner .
We are not there yet , but progress is being made . I have learned that it is possible to change systems in the NHS , but that it takes persistence , networking , and a whole lot of patience .
Words LUCY SWIFT , Senior Occupational Therapist , Pain Management and Rehabilitation Team , Royal National Orthopaedic Hospital , l . swift @ nhs . net . Visit the Greener AHP Hub for advice on reducing the environmental impact of equipment , medicines and resources and how you can make a positive impact towards net zero bit . ly / 45GAXI4
September 2023 OTnews 15